鼻咽通气管对预防重度阻塞性睡眠呼吸暂停综合征术后呼吸道并发症的临床意义  

Nasopharyngeal tube prevents the postoperative respiratory complication of severe obstructive sleep apnea hypopnea syndrome

作　　者：周旭[1] 王建中[1] 吴钦苏[1] 常荣先[1] 黄新生[1] 黄凤娥[1] 

机构地区：[1]复旦大学附属中山医院耳鼻喉科,上海200032

出　　处：《复旦学报（医学版）》2007年第3期383-386,共4页Fudan University Journal of Medical Sciences

摘　　要：目的探讨重度阻塞性睡眠呼吸暂停综合征患者悬雍垂腭咽成形术后使用鼻咽通气管能否明显降低术后呼吸道并发症的发生率。方法治疗组为43例经多导睡眠呼吸监测(polysomnography,PSG)或脉搏传导时间(pltlse transit time,PTT)确诊为重度阻塞性睡眠呼吸暂停综合征(AHI>40或S2O2<65％)的患者,悬雍垂腭咽成形术(UPPP)后置鼻咽通气管(内径8 mm,长度自鼻腔到舌根下方、会厌髏上方)。对照组为22例经PSG确诊为重度阻塞性睡眠呼吸暂停综合征的患者,悬雍垂腭咽成形术后未置鼻咽通气管,其余治疗均与治疗组相同。两组患者术后均行心电及血氧饱和度监测。比较两组患者术后24 h、48 h的呼吸困难、最低血氧饱和度、咽部疼痛、咽部水肿情况。结果UPPP术后24 h内,呼吸困难治疗组0分,对照组(0．23±0．43)分,两者的差异有统计学意义(P<0.01);最低血氧饱和度治疗组(0．37±0．54)分,对照组(1．23±0．72)分,两者的差异有统计学意义(P<0．01)。咽部疼痛治疗组(2．30±0．56)分,对照组(2．27±0．55)分,两者的差异无统计学意义(P>0．01),咽部水肿治疗组(1．21±0．41)分,对照组(1．23±0．69)分,两者的差异无统计学意义(P>0．01), UPPP术后48 h,呼吸困难治疗组与对照组均0分,两者无差异;最低血氧饱和度治疗组(0．51±0．59)分,对照组(1．09±0．81)分,两者的差异有统计学意义(P<0．01),咽部疼痛治疗组(1．60±0．62)分,对照组(1．62±0．70)分,两者的差异无统计学意义(P>0．01);咽部水肿治疗组(1．10±0．56)分,对照组(0．98±0．63)分,两者的差异无统计学意义(P>0．01)。结论UPPP术后使用鼻咽通气管可明显降低重度阻塞性睡眠暂停低通气综合征患者悬雍垂腭咽成形术后呼吸困难的发病率,是保证上气道畅通的重要手段,且只需使用24 h。鼻咽通气管对改善重度阻塞性睡眠暂停低通气综合征的低氧血症也有明显的疗效。Purpose To investigate the effects of nasopharyngeal tube on the postoperative respiratory complication of uvulopalato pharyngoplasty（UPPP） of patients with severe obstructive sleep apnea hypopnea syndrome（OSAHS）. Methods The assessing parameter included decompensation, the lowest S4O2, pharynx ache, and pharynx edema in 43 patients（treated group） with nasopharyngeal tube after UPPP and 22 patients （control group）without nasopharyngeal tube after UPPP. Two groups were compared in 24 hours and in 48 hours. Nasopharyngeal tube （diameter 8 mm） was placed from the nasal cavity to the lower of the tongue base. Results In 24 hours after UPPP, there was significant difference （P〈0. 01）in decompensation between the treated group （0） and the control group （0.23 ± 0.43）, there was significant difference in the lowest oxygen saturation （P〈0.01） between the treated group （0.37±0.54） and the control group （1.23 ±0. 72）; there was no significant difference in pharynxache（P〉0. 01） between the treat group （2. 30±11.56） arid the control group （2. 27 ± 0. 55） ; there was no significant difference in pharynx edema（P〉0. 01 ） between the treated group （1. 10±0. 56） and the control group （1.23 ±0.69）. In 48 hours after UPPP, there was no significant difference indecompensation （P〉0.01） between the treated group （0） and the control group （0）： there was significant difference in the lowest oxygen saturation （P〈0.01） between the treated group （0.51 ± 0.59） and the control group （1.09 ±0.81） ; there was no significant difference in pharynx ache （ P〉0. （11） between the treat group （1.60 ±0. 62） and the control group （ 1.62 ± 0.70） ; there was no significant difference in pharynx edema （P〉0. 01） between the treated group （1. 10±0. 56） and the control group （0.98 ± 0. 63）. Conclusions Nasopharyngeal tube may significantly decrease the incidence of decompensation and the lowest oxygen saturation

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 悬雍垂腭咽成形术 并发症 鼻咽通气管 

分 类 号：R762[医药卫生—耳鼻咽喉科]